Kelleher Thomas B, Mehta Shruti H, Bhaskar Ramakrishnan, Sulkowski Mark, Astemborski Jacquie, Thomas David L, Moore Richard E, Afdhal Nezam H
Liver Center, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis Street, Suite 8E, Boston, MA 02215, USA.
J Hepatol. 2005 Jul;43(1):78-84. doi: 10.1016/j.jhep.2005.02.025. Epub 2005 Apr 25.
BACKGROUND/AIMS: To examine if serum fibrosis biomarkers could accurately identify the stage of liver disease amongst hepatitis C (HCV) and HIV co-infected patients.
One hundred and thirty seven HIV/HCV co-infected persons were randomly selected from the Johns Hopkins HIV Clinic cohort. Ninety five had complete testing for fibrosis markers in sera collected at the time of liver biopsy. Biopsies were scored according to Ishak modified histological activity index (F0 no fibrosis to F6 cirrhosis). Fibrosis was evaluated against alanine aminotransferase (ALT), aspartate aminotransferase (AST), AST to platelet ratio (APRI), albumin, total bilirubin, hyaluronic acid (HA) and YKL-40.
Sixty nine (73%) had no or minimal portal fibrosis (F0-2) and were compared with remaining subjects (F3-6). Fibrosis scores > or =F3 were found 27 times more often in persons with HA levels >86 ng/ml and 5.5 times more often in persons with HA levels 41-86 ng/ml. Less substantial associations were detected with levels of albumin <3.5 g/dl (OR 4.85) and AST >60 iu (OR 5.91). All 35 subjects who had favorable results of HA, albumin, and AST had minimal fibrosis (F0-2).
Amongst HIV/HCV co-infected patients, serum testing for HA, albumin, and AST (SHASTA Index) was able to accurately stage mild and advanced fibrosis.
背景/目的：探讨血清纤维化生物标志物能否准确识别丙型肝炎病毒（HCV）和人类免疫缺陷病毒（HIV）合并感染患者的肝病分期。
从约翰霍普金斯HIV诊所队列中随机选取137例HIV/HCV合并感染患者。其中95例在肝活检时采集的血清中进行了完整的纤维化标志物检测。活检根据Ishak改良组织学活动指数进行评分（F0无纤维化至F6肝硬化）。针对丙氨酸氨基转移酶（ALT）、天冬氨酸氨基转移酶（AST）、AST与血小板比值（APRI）、白蛋白、总胆红素、透明质酸（HA）和YKL-40评估纤维化情况。
69例（73%）患者无或仅有轻度门脉纤维化（F0-2），并与其余患者（F3-6）进行比较。HA水平>86 ng/ml的患者中纤维化评分≥F3的发生率是其他患者的27倍，HA水平为41-86 ng/ml的患者中该发生率是其他患者的5.5倍。白蛋白水平<3.5 g/dl（比值比4.85）和AST>60 iu（比值比5.91）时也发现了不太显著的相关性。HA、白蛋白和AST检测结果均良好的所有35例患者纤维化程度均较轻（F0-2）。
在HIV/HCV合并感染患者中，检测血清HA、白蛋白和AST（SHASTA指数）能够准确区分轻度和重度纤维化分期。
